In Vitro Fertilization Protocol

In Vitro Fertilization (IVF) is one of the most effective treatments available to help potential parents achieve pregnancy. Most patients will have a 25% to 45% probability of a successful pregnancy per IVF procedure at Bay IVF Center. In addition to being a very powerful treatment for infertility, IVF is an excellent test of egg and sperm quality.

 

In Vitro Fertilization treatment consists of:

1. Ovarian stimulation to induce growth of multiple eggs within the ovaries.
2. Ultrasound guided egg retrieval.
3. Fertilization of the eggs.
4. Transfer of the resulting embryo(s) into the uterus.
5. Establishment of pregnancy.

This is an example of an IVF treatment sequence. Actual treatment is individualized:

 

 

1. Ovarian Stimulation

    

   IVF treatment begins with the onset of a menstrual period. Oral contraceptives are started within the first seven days of the menstrual cycle. They prime the ovaries for an optimal response. Seven to ten days before the estimated onset of the next menstrual period, Lupron injections begin. Lupron prevents premature release of the eggs from the ovaries prior to the egg retrieval procedure. The Lupron injections are given subcutaneously (just under the skin). These injections are administered daily for approximately three to four weeks.

    

   After seven to ten days of taking Lupron, a menstrual period will start. Within two weeks of the onset of the period, follicle stimulating hormone (FSH) injections are added to the Lupron. FSH stimulates maturation of multiple eggs in the ovaries. FSH injections, like Lupron, are given subcutaneously with tiny needles. FSH injections are administered daily for approximately ten days.

    

   During this time, the progress is monitored by ultrasound and estradiol (estrogen, E2)  blood levels. Once the eggs are ready, the Lupron and FSH are stopped and a single injection of Human Chorionic Gonadotropin (HCG) hormone is taken. This is also a subcutaneous injection. This medication triggers the final stages of egg maturation. Thirty-six hours after the HCG injection, the eggs are aspirated from the ovaries.

    

2. Ultrasound Guided Transvaginal Egg Retrieval

    

   Using ultrasound guidance, a tip of a thin needle is passed through the top of the vagina into the cul-de-sac (a space behind the uterus). The ovaries are located near the bottom of the cul-de-sac allowing the tip of the aspirating needle to enter the ovarian follicles and aspirate the follicular fluid from them. The fluid is examined under a microscope to identify the eggs. The egg retrieval takes approximately five to ten minutes. Medications are used for pain relief. It is possible to have a short lasting menstrual-like cramp sensation when the tip of the needle passes through the top of the vagina (once for each ovary). The actual follicle aspiration is typically not felt by the patient. The egg retrieval is a very safe procedure.

    

3. IVF Laboratory

    

   On average, eight to fourteen eggs are aspirated during the egg retrieval procedure. The eggs are identified under the microscope and are placed in culture medium filled petri dishes. The composition of the medium resembles the fluid secreted by the Fallopian tubes. This allows the eggs and embryos (fertilized eggs) to develop in the laboratory environment at the same rate as inside the Fallopian tubes 

    

   The male partner collects a semen specimen by masturbation (unless sperm aspiration is needed) the day of the egg retrieval. The highest quality sperm are extracted from the semen and are combined with the eggs six hours after the egg retrieval. The process of fertilization takes place over a period of several hours during the night.

    

   If the fertility history suggests a possibility of male infertility significant enough to keep the eggs from being fertilized this way, Intracytoplasmic Sperm Injection (ICSI) is performed. In ICSI, a single sperm is inserted into an egg. This can significantly increase the fertilization rate for selected patients.

    

   Evidence of fertilization can be seen the next day, 14 to 16 hours after insemination. The fertilized eggs are transferred into growth medium and continue to be cultured in the IVF laboratory.

    

4. Embryo Transfer

    

   The embryo transfer is performed one to five days after the egg retrieval. The embryo(s) is/are "loaded" into the tip of a very thin embryo transfer catheter in a very small volume of transfer medium. The catheter is then passed through the cervical canal to within 5 mm of the top of the uterine cavity and the embryo(s) are gently released. The transfer usually takes only a few seconds to complete. No resting is required afterwards.

    

   The Gamete Embryologists assess the embryos prior to the embryo transfer to determine their likelihood of implantation. Most partners usually select two to four embryos for the transfer. Approximately one-third of IVF pregnancies are twins and there are very few triplet or higher order pregnancies.

    

   There may be more embryos than the future parents wish to have transferred. It is possible to cryopreserve (freeze) these embryos and store them in liquid nitrogen. The majority of the embryos should survive the cryopreservation and thawing process. The implantation rate of the surviving embryos is similar to the "fresh" embryos.

    

5. Establishment of Pregnancy

    

   After the embryo transfer, the front and back walls of the uterus gently hold the embryos, keeping them within the uterus. There is no restriction of physical or sexual activity.

    

   The lining of the uterus is made receptive for the embryos through the action of the hormones estrogen and progesterone produced by the ovaries. Ovarian progesterone production is supplemented with vaginal progesterone capsules or cream.

    

   A blood pregnancy test is done approximately two weeks after the embryo transfer. If the pregnancy test is positive, an ultrasound examination is scheduled two weeks later to visualize the implantation site and to look for a heartbeat. Once a heartbeat is seen, there is a 90% to 95% probability that the pregnancy will continue to a baby. From that point on, the pregnancy becomes indistinguishable from a pregnancy conceived through intercourse.

 

If you have any questions regarding In Vitro Fertilization or to request an appointment, please contact us by phone at 650-322-0500, via email at care@BayIVF.com, or use the Contact Bay IVF Center form on this page.